Constipation is a common issue that most people will face at some point. A diet high in fiber, regular exercise and drinking plenty of water are simple ways to help prevent constipation.
Constipation is a common condition in which a person has either fewer than three bowel movements a week, or bowel movements with stools that are hard and painful to pass.
Symptoms of constipation may include hard, difficult to pass stools, greater than normal time between bowel movements, nausea, painful cramping, and bloating.
Constipation may be caused by a diet low in fiber, lack of exercise, or not drinking enough fluids. Some medications can cause constipation, as can certain underlying medical conditions.
Treatment depends on the cause, severity, and duration of the constipation, and may include changes in diet, lifestyle and exercise, and sometimes medication therapy. More serious causes of constipation may require surgery. Laxatives include fiber supplements, which are safe and are not habit-forming. Softeners such as docusate sodium are emollient laxatives and might take a week or longer to be effective. Osmotic laxatives draw fluids from surrounding tissues into the intestines, making stools easier to pass. Stimulant laxatives accelerate the movement of stool through the colon. They work quickly (within hours) and often cause diarrhea and cramping. Use of stimulant laxatives should be limited as overuse can lead to laxative dependence.
Symptoms of constipation may include:
- hard, difficult to pass stools
- time between bowel movements greater than normal for you
- painful cramping
Common causes of constipation include:
- inadequate fiber intake
- inadequate liquid intake
- lack of physical exercise
- certain medications including:
- pain medications, especially narcotics
- antacids that contain aluminum and calcium
- calcium channel blockers (especially verapamil)
- medications used to treat Parkinson’s disease
- antispasmodics—medications that prevent sudden muscle contractions
- some antidepressants
- calcium supplements
- iron supplements
- anticonvulsants—medications that decrease abnormal electrical activity in the brain to prevent seizures
- over-the-counter laxative overuse
- life changes or daily routine changes (travel can aggrevate constipation)
- repeatedly ignoring the urge to have a bowel movement
- neurological and metabolic disorders such as multiple sclerosis, Parkinson's disease, diabetes, and thyroid disorders
- GI tract problems
Tests are not usually necessary in order to diagnose constipation. Very few people with constipation have a serious medical condition. See your healthcare provider if your constipation lasts for more than 2 or 3 weeks.
Your healthcare provider may ask how long the symptoms have been present, the frequency of your bowel movements, the consistency of your stools, and if there is visible blood in the stool. You may be asked to explain your eating habits, the medications you are taking, and your level of physical activity.
A physical exam and a test for blood in the stool may be performed.
Tests your doctor may perform to diagnose the cause of your constipation may also include:
- blood tests
- barium studies
To prevent and manage constipation when it occurs, try to incorporate the following steps into your lifestyle:
- Increase fiber intake. Try to get at least 30 gm of fiber each day. Eat at least 2 to 3 servings of fruit, 5 servings of vegetables and 5 servings of bran or other high fiber cereals and breads.
- Increase fluid intake. This is very important as adding fiber to your diet without increasing your fluids can cause or worsen constipation.
- Exercise regularly.
- Practice good bowel habits. Go to the bathroom when you get the urge to defecate.
These steps may successfully treat or prevent constipation in the vast majority of people. However, if after 2 or 3 weeks your constipation is not getting better, your healthcare provider might recommend adding a laxative.
There are a variety of laxatives that come in pills, capsules, and liquids suppositories and enemas and each have a different mode of action:
- Fiber supplements (bulking agents) are safe and are not habit-forming, as some stimulant laxatives may become with overuse or abuse. These agents are usually tried first. Fiber supplements may take months to reach full effectiveness. Psyllum (Metamucil), Citrucel, Fiber-Lax, Benefiber are examples of fiber supplements. Fiber supplements should only be used if adequate fluid intake can be maintained.
- Softeners, or emollient-laxatives, might take a week or longer to be effective. Docusate Sodium (brand name Colace) is an example of a softener.
- Osmotic laxatives draw fluids from surrounding tissues into the intestines, making stools easier to pass. This process may take days to have any effect.
- Stimulant laxatives accelerate the movement of stool through the colon. They work quickly (within hours) and often cause diarrhea and cramping. Use of stimulant laxatives should be limited as over-use can lead to laxative dependence. Examples include Ex-Lax, Senokot, Correctol, Dulcolax, and Feen-a-Mint.
The laxative that best suits you will depend on your degree of mobility, fluid and fiber intake and bowel function. Talk to your healthcare provider before starting any of these medicines.